日间手术延期恢复模式下完全腹膜外与经腹腹膜前疝修补术在老年腹股沟疝中的应用  

The application of totally extraperitoneal and transabdominal preperitoneal herniorrhaphy in the elderly inguinal hernia under the delayed recovery mode of ambulatory surgery

作　　者：冯伟 汪启乐 王盛 侍继东 林斌 FENG Wei;WANG Qi-le;WANG Sheng(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Suqian Hospital of Xuzhou Medical University,Suqian 223800,China)

机构地区：[1]徐州医科大学附属宿迁医院肝胆胰外科,江苏宿迁223800

出　　处：《腹腔镜外科杂志》2021年第6期426-429,共4页Journal of Laparoscopic Surgery

摘　　要：目的:对比日间手术延期恢复模式下完全腹膜外疝修补术(TEP)与经腹腹膜前疝修补术(TAPP)治疗老年腹股沟疝的效果。方法:采用回顾性病例对照研究方法分析2019年1月至2020年1月收治的日间手术延期恢复模式治疗的94例老年腹股沟疝患者的临床资料,其中TEP组40例,TAPP组54例,观察两组手术时间、术中并发症、术后疼痛程度、持续时间、术后并发症(尿潴留、腹胀、呕吐、慢性疼痛、感觉异常)、治疗费用及术后复发率等。结果:两组手术时间、术中出血量、治疗费用差异均无统计学意义(P>0.05),TEP组术后疼痛程度及持续时间、术后腹胀发生率低于TAPP组,两组差异有统计学意义(P<0.05)。两组术后6个月进行随访,无明显慢性疼痛、感觉异常及复发病例。结论:TEP与TAPP治疗老年腹股沟疝均具有安全性良好、创伤轻、康复快等优势,但TEP由于减少了对腹腔脏器的干扰,更利于快速康复,在降低术后疼痛、并发症发生率方面更利于在日间手术延期恢复模式下开展。Objective:To compare the clinical effect of total extraperitoneal(TEP)and transabdominal preperitoneal(TAPP)herniorrhaphy for elderly inguinal hernia under the delayed recovery mode of ambulatory surgery.Methods:A retrospective case-control study method was used to analyze the clinical data of 94 elderly patients with inguinal hernia who were treated in the delayed recovery mode of ambulatory surgery from Jan.2019 to Jan.2020,there were 40 cases in TEP group and 54 cases in TAPP group.The operation time,intraoperative complications,postoperative pain degree and duration,postoperative complications(urinary retention,abdominal distension,vomit,chronic pain and paresthesia),treatment cost and postoperative recurrence rate of the two groups were observed and compared.Results:There were no significant differences between the two groups in terms of operation time,intraoperative blood loss or treatment costs(P>0.05).However,the degree and duration of postoperative pain and the incidence of postoperative abdominal distension in the TEP group were less than those in the TAPP group,and the differences between the two groups were statistically significant(P<0.05).Patients in the two groups were followed up for 6 months,and no obvious postoperative chronic pain,paresthesia or recurrence was found.Conclusions:TEP and TAPP repair have the advantages of favorable safety,few trauma and rapid postoperative recovery in the treatment of elderly inguinal hernia.However,TEP reduces the interference to abdominal organs and is conducive to the accelerated recovery of patients,and reduces postoperative pain and complications.TEP is more conducive to the delayed recovery mode of ambulatory surgery.

关 键 词：疝 腹股沟 完全腹膜外 经腹腹膜前 疝修补术 腹腔镜检查 日间手术延期恢复 

分 类 号：R656.2+1[医药卫生—外科学]